AB0478 LUPUS ANTICOAGULANT IS ASSOCIATED WITH PROSPECTIVE ECHOCARDIOGRAPHIC CHANGES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A FIVE-YEAR FOLLOW-UP STUDY
Authors: K. A. Myhr, M. M. Jepsen, A. Hempel Zinglersen, K. K. Iversen, M. L. F. Hermansen, A. T. Ngo, R. Pecini, S. Jacobsen
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic lupus erythematosus (SLE) is an autoimmune disease with increased risk of cardiovascular complications such as coronary artery disease, myocarditis, pericarditis, and valvular dysfunction (1─3). The pathophysiological mechanisms are poorly understood and markers to identify high risk patients are warranted. Objectives We aimed to identify SLE-characteristics that are associated with progressive cardiac dysfunction. Methods A total of 108 patients with SLE (90 % female, mean age 46±13 years, median disease duration of 14 (7-21) years) were included from 2013 to 2014. Blood samples were collected with inclusion of biomarkers, and a standard echocardiography was performed at baseline and at a five-year follow-up. Multivariate regression analyses with five independent lupus-specific baseline variables of interest (disease activity, lupus nephritis, anti-cardiolipin and/or anti-beta-2 glycoprotein I antibodies, and lupus anticoagulant (LAC)) were performed for the association with baseline echocardiographic parameters as well as for changes during follow-up. Results During the five-year follow-up period, left ventricular (LV) end-diastolic volume index increased from 43.5±13.9 to 52.5±15.7 ml/m 2 (p &lt;0.001) (Figure 1 A1), and LV diastolic parameters declined (E/A ratio 1.4±0.5 vs. 1.3±0.5, p=0.002; e’ velocity 12.8±3.8 vs. 12.0±3.7 cm/s, p=0.02; mitral valve deceleration time 227.9 vs. 200.8 ms, p=&lt;0.001), except for E/e’ (7.5±3.8 vs. 6.8±3.4, p=0.02) (Figure 1B1) in the entire SLE population. LV ejection fraction remained stationary (59.5±6.8 vs. 59.6±6.4 %, p=0.81). Presence of LAC was associated with progressive LV dilatation during the follow-up period (p=0.005) (Figure 1 A2) but not baseline LV volumes (p=0.35). LAC was associated with lower E/A ratio at baseline (p=0.006) but did not predict a decrease of E/A ratio during follow-up (p=0.09) (Figure 1 B2). Follow-up changes of other echocardiographic parameters were not associated with any of the lupus-specific variables. Figure 1. Left ventricular end-diastolic volume index (LVEDVI) (A) and E/A ratio (B) at baseline and follow-up (A1, B1) as well as paired longitudinal changes as density plots (A2, B2) with mean values (dashed lines) according to the presence of LAC (blue). LVEDVI and E/A ratio at baseline were log-transformed due to non-normality. Conclusion Presence of LAC was associated with lower E/A ratio at baseline as well as progressive left ventricular dilatation during a five-year follow-up period. Hence, LAC might be a predictor of progressive cardiac dysfunction in SLE patients. LAC is known to have implications for the microvascular circulation, but the clinical significance of the present findings is yet to be elucidated. References [1]Yafasova A, Fosbøl EL, Schou M, Baslund B, Faurschou M, Docherty KF, et al. Long-Term Cardiovascular Outcomes in Systemic Lupus Erythematosus. J Am Coll Cardiol. 2021 Apr 13;77(14):1717–27. [2]Aviña-Zubieta JA, To F, Vostretsova K, De Vera M, Sayre EC, Esdaile JM. Risk of Myocardial Infarction and Stroke in Newly Diagnosed Systemic Lupus Erythematosus: A General Population-Based Study. Arthritis Care Res. 2017 Jun;69(6):849–56. [3]Zuily S, Regnault V, Selton-Suty C, Eschwège V, Bruntz J-F, Bode-Dotto E, et al. Increased risk for heart valve disease associated with antiphospholipid antibodies in patients with systemic lupus erythematosus: meta-analysis of echocardiographic studies. Circulation. 2011 Jul 12;124(2):215–24. Disclosure of Interests None declared